The Congress’ balancing act aimed at increasing nation’s debt, and decreasing federal spending has quite expectedly singled out Medicare – which is one of the priority spending sectors in the Federal Budget – as the nucleus of its growing deficit budget, and the one that requires immediate controlling measures either in terms of careful structural reform to the Medical Sustainable Growth Rate (SGR), or blunt across-the-board 2% cut to Medicare and other domestic programs. What is alarming is that the accumulated SGR is pegged at a negative 21.3% for 2011, though deferred till the end of the year, would have meant a drastic 21.3% cut to physicians bills for Medicare beneficiaries.

Having already come in for widespread criticism from all the stakeholders, the implementation will have serious repercussions across the spectrum of nation’s primary healthcare sector: Medicare Physicians, Beneficiaries, Medicare Insurance Carriers, and Medicare Billing Companies.

Medicare Physicians, who are already finding it impossible to serve Medicare beneficiaries for fees well below the market-driven rates, would find it even more tougher to balance their operating costs and revenues, and consequently be driven to reconsider their services for Medicare beneficiaries in the aftermath of such recommendation on Medicare.

Medicare Beneficiaries, who are already at loss finding suitable Medicare physicians, will find it even harder if the Medicare physicians consider migrating to private practice altogether, forcing Medicare beneficiaries spend at market-driven health cost. Further compounding the issue is the fact that the imminent percentage of seniors waiting to swell the-already-brimming dam of Medicare beneficiaries.

Medicare Insurance, which accounts for a majority of medical insurance reimbursement, would adversely be hit in as far is its percentage of medical insurance share is concerned should there be an exodus of Medicare beneficiaries to private insurance carriers.

Medical Billing Companies that until now considered Medicare processing as one of their priority businesses will be compelled to relegate Medicare down their portfolios of insurance carriers.

Having carried forward the perennially cumulative negative Sustainable Growth Rate (SGR) for more than a decade in the lager interest of Medicare beneficiaries (comprising senior citizens), the Federal Government has realized the proportion of negative impact of Sustainable Growth Rate on its fiscal composition and effectiveness of Medicare. Accordingly, it is contemplating either to repeal the Sustainable Growth Rate (SGR) formula for Medicare (meaning further Federal deficit to already trouble-stricken economy) or phased writing-off of the cumulative Sustainable Growth Rate projected to yield $575 billion in savings in the first 10 years (meaning a drastic reduction in payments to physicians attending Medicare beneficiaries, which could affect the physicians’ motivation level for serving Medicare patients).

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), which is the largest consortium of medical billers with a deep concern for the medical billing market in the U.S., hopes that the Federal Government – having to tread on a thin line – will eventually come up with a solution that, apart from ensuring a balanced health budget, fosters Medicare as the health scheme promoting multiple stakeholders’ interests: Medicare Physicians, Medicare Beneficiaries, Medicare Insurance Carriers, and Medical Billing Companies catering to Medicare beneficiaries.

Healthcare Information Exchange is the end goal of the recent health reforms in the United States and aims to provide better patient care on a continual basis by multiple organizations. The implementation of HIE not only helps in providing quality care to patients but also assists in reducing costs and errors that arise due to duplicate tests, cost of paperwork, and other manual efforts such as scanning of documents, printing, and traditional procedures that consume time and money. Since HIE is still in its implementation stage, many health care providers, hospitals and the government are facing numerous challenges in this area.

Meaningful Use

The biggest hurdle that the government and physicians are facing is the Meaningful Use of EMR. Physicians, clinics, and hospitals have to demonstrate that they have been using the IT reforms in a meaningful manner and this entails numerous requirements to be met. These can range from recording the smoking status of patients above the age of 13 years to providing e-prescriptions. Many physicians are finding it hard to implement the technology and successfully demonstrate meaningful use due to many reasons. Some of these include resistance to new technology by the staff or physicians, older physicians who are set to retire in a few years and are reluctant to adopt such technology, and the possible adverse legal implications of successfully implementing EMR and EHRs.

Legal Implications

The utilization of HIE can have legal implications for small providers of EHR systems but larger government sponsored providers face lesser risks in the form of legal actions. Moreover, physicians and hospitals may face legal penalties if the system is not used in an appropriate manner which can lead to reduced quality of patient care. The legislation regarding HIE and EMRs or EHR is still being developed and this uncertainty and lack of proper regulations in the initial stages of the HIE implementation is creating anxiety among health care providers.

Costs

Health Information Exchange is a complicated and sensitive issue where there is very little scope for errors and so the costs for implementation and utilization over longer periods of time are another problem physicians and the government is facing. The major issue as far as costs are concerned is the downtime costs which would be borne by physicians. If the HIE or EMR systems are down even for a short period of time, it can cost the physicians a lot of money and result in a drop in their revenue. As many physicians and hospitals scramble to implement Electronic Health Records to assist in the HIE process, this aspect of system downtime is sometimes ignored by system providers and health care providers as well.

Privacy

The biggest concern that physicians and patients have is the privacy of their records since there are many professionals who would have access to their health information. Since the information shared by them can be misused by many agencies such as competing insurance companies, training physicians, pharmaceutical companies and unauthorized research agencies, there certainly is a growing concern over the security of such sensitive data.

Solutions

There are many opinions, debates and solutions which are being proposed to meet these Healthcare IT sector reform challenges. However, some of the most simple and cost effective measures are physician education about HIE, legal reforms related to HIE, ensuring technical efficiency, and better administrative processes including efficient medical billing and coding, medical transcription, lesser turnaround time and efficient interaction with payers. In fact, to focus on optimizing your processes in keeping with the HIE injunctions you could hire the support of excellent consultants. These HIE specialists have the capability of directing your precious time and effort towards implementation of technology and processes rather than creating trouble.

Although there are various challenges faced by HIE in the United States, it is possible to successfully implement it with the help of experienced HIE and revenue cycle consultants. For more information regarding healthcare IT reforms and end to end revenue cycle consultancy you can visit medicalbillersandcoders.com – the largest consortium of medical billing professionals across all states, handling all specialties.

Going by a recent survey by the researchers with Cornell University and University of Toronto – which has unearthed alarming fact about relatively higher administrative costs in the United States: physician practices incurring nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts – it is quite imaginable the extent of its implication on physicians’ fees, and patients’ medicals bills ultimately. The fact that the survey has treated Canadian medical quality on par with that of United States, ranked highest globally, further endorses the need for immediate insurance-related administrative reforms that can drastically:

Bring down the per-capita physician administrative cost to as low as $22,205

Reduce time spent by nurses and medical assistants on administrative tasks related to health plans to as low as 2.5 hours per physician per week, which is what prevailing in Canada, and

Easier said than done, the reform measures should effectively address multiple issues that have been responsible for this undesirable scenario. While running a thorough analysis on reasons responsible, the researchers have identified the following areas that require reformatory action:

Multiple-payer health care system: The prevalence of multiple-payer health care system has been both complex with different sets of regulations, procedures and forms mandated by each health insurance plan or payer, as well resource-consuming. Ideally, multiple-payer health care system needs to be simplified into either two-payer system – one each for private and Federal insurance plans – or, if possible, single-payer system that Canadian physicians follow.

Failed Experimentation with in-house medical billing: Experimentation with in-house medical billing practice has not been encouraging either – either in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system-implementation. Consequently, physicians – with no avail but to practice medical billing somehow – have to bear the brunt of excessive operational costs.

Unscrupulous Medical Billing companies: There have been instances where in solution-seeking physicians/hospitals have run into some unscrupulous medical billing company or medical billing agency, who contrary to ensuring cost optimization and revenue maximization, have further compounded their clients’ woes by sending out wrong bills in an incorrect format.

Amidst such complex problems, the ensuing Affordable Care Organization (ACO) floated by Patient Protection and Affordable Care Act of 2010 (PPACA), scheduled to be officially launched in January 2012, promises to bring down spiraling health expenditure through

While these reformatory measures are greatly welcome, physicians/hospitals should inevitably carry on seeking professional help of expert medical billing specialists that are competent enough to tackle spiraling administration costs, and ensure operational efficiency and revenue maximization.

Medicalbillersandcoders.com, the largest consortium of medical billing professionals, brings certified medical billers and coders from all 50 states under one roof. With the average experience of billers in this consortium to be 7 years, you can find well trained in-house billers and well equipped medical billing agencies in your city.

These billing professionals are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards, riding on unparalleled set of pre-qualifiers – certified by the American Association of Professional Coders (AAPC).

Expert at applying standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis; and an impressive track-record of maximum and efficient reimbursement of medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group and Government sponsored Medicare and Medicaid as well – is uniquely poised to complement physician cost-minimization and revenue-maximization endeavors.

The Primary Health Care (PHC) system in the US has so far served as a platform for providing frontline care with services provided by medical professionals ranging from family physicians and assistants, internal medicine specialists, nursing practitioners and clinicians.

However, the diversity in patient backgrounds and medical needs of individuals, special needs patients (e.g. disabled persons or community crisis victims) along with the wide spectrum of the care demanded can take a toll on veteran medical experts, so it’s quite easy to imagine what newly qualified PHC professionals or facilities have to deal with.

PHC Burnout Reasons Regarded as the quarterback of primary patient care, clinicians have issues of performing at optimum levels consistently, since they are the first point of contact for health problems that have so far not been diagnosed, have the responsibility of providing comprehensive personal care and also building long-term relationships with patients who come in with chronic problems.

Now, add to these duties, the necessity of effectively coordinating across multiple sectors for ensuring health services offered at their clinic are customized for all patients, in the correct setting and provided by the most appropriate medical expert in keeping with a patient’s values and it is easy to understand why PHC professionals are often stressed and overworked.

PHC professionals have to manage key stakeholders, such as employees, legislators and patients in addition to their increasing workload, with fewer trainees and support care personnel available to meet with rising demands of quality primary healthcare and strict government policies.

Having to further work within the narrow confines of antiquated administrative systems of Primary Health care delivery further debilitates PHC providers.

PHC providers need efficient, measurable and guaranteed systems for integrating different primary care disciplines so they can ensure advanced support, adequate community networking and improved primary care services for a wide range of patients – without having to commit hands-on time or labor for transforming their practice.

Solutions For Growing Primary Health Care Services Learning about new models of PHC, latest clinical innovations, exposure to the latest billing and coding software, having access to reformed curriculums and medical billing and coding systems that augment the nature of services provided by Primary health care professionals are some ways of solving the problems of burned out physicians specializing in PHC. However, it may not be practical for many Primary Health Care practitioners to personally handle all of these issues or even acquire trained, dedicated and experienced staff in-house to manage competencies needed for enhanced primary care without significantly affecting revenue.

Here is where outsourcing certain competencies to specialized medical billing and coding companies and firms trained to provide expert administrative support services to medical practitioners, clinics and healthcare centers can play an important role in transforming the way medical care is provided. In addition to the growing number of patients a PHC provider or organization serves, the government adds more duties through laws and regulations, making this burden even heavier especially on the primary healthcare professional, the first-contact medical help provider.

Though government initiatives are aimed at reducing the patients’ burden by providing Medicare and Medicaid to improve the quality of service – via enforcement of PQRS (Physician Quality Reporting Service), setting up and maintenance of Electronic Health Record (EHS) systems – these additional regulations and procedures place an extra burden on the physician. They involve setup costs, maintenance, staff and training etc. -facts that should be considered seriously by PHC providers keen to build credibility without neglecting revenue optimization for their practice.

PQRS requires doctors to report to a particular set of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. This is no easy task, since PQRS helps the physician gain credibility in his or her work sphere, but the cost implications far outweigh this advantage for most PHC providers. Sourcing support staff or training existing staff to use this new and complex technology can be time-consuming and a drain on resources.

However, using the services of professionals like Medicalbillersandcoders.com to hire skilled CPC certified coders and CCHIT certified-software can help the physicians to focus on quality of patient care by PQRS participation while these experts ensure a healthy revenue generation for the organization.

Specialist medical billing and coding firms such as medicalbillersandcoders.com cater to individual professionals as well as large hospitals. HIPAA compliancy, insurance pre-authorization, denial management and appeals, account receivables, as well as customized consultancy services for optimizing revenue cycle management – you name it and their team members are certified and well equipped to handle every administration duty you can think of!

So, if you are a Primary Care Physician jostling with hundreds of changes in the healthcare industry and want to optimize your revenue, click www.medicalbillersandcoders.com to learn more!

HostGator offers a number of web hosting services. Before we tell you about one of the distinctive features of HostGator, HostGator coupon, we should have a look onto those services offered by HostGator. Current offer:

Author

Medical Billers and Coders is the largest consortium of Medical Billers and Coders in the United States. Our aim is to help the physician community to reach the right expertise in the right location at the right time.